Getting your hands dirty

I’ve got dirt under my fingernails from pulling weeds.  If you don’t keep after them they try to take over.  Some weeds are easy to get rid of.  A little Weed and Feed and they die off. Some others are incredibly persistent. If I spot some Dollar Weed I go right to DEFCON 1 and blast it with weed killer and dig up the roots.  That is the only way to get rid of it.

If you see some warts on your kid today think about me and my weeds.  Warts are similar to weeds with one major difference. Humans have an immune system to help fight them (more on this later).

So if you see a wart go out and buy some Compound W, Dr Scholl’s or other similar brand.  All of these products contain salicylic acid.  It can be in a thick liquid or in a sticky pad.  You apply it to the wart once a day and cover it with some duct tape or band-aid.  Be persistent! This will take some time.

It does not pay to be overly aggressive. For example I can freeze the warts for you at my office.  Alert. Small children do not enjoy painful experiences.  I still remember my family doctor burning a wart off of my thumb 45 years ago.  The freezing will usually work, but sometimes the wart will return in a few weeks.  Sometimes I freeze one wart and 2 come back! There are other painful destructive methods to treat warts such as Cantharidin (beetle juice) or even surgery.  As I said small children are usually not happy about these methods.

Which brings me back to the immune system.  Warts are an infection caused by the Human Papillomavirus or HPV. Given some time the human body will usually eliminate the virus without any intervention from us.  However I do believe it is smart to keep irritating and annoying the weeds (I mean warts) with the Compound W (salicyclic acid).  Don’t stop harassing them because they can spread and take over. Keep giving them a haircut!

Importantly,  by irritating the warts you activate and stimulate the immune system so that it will start attacking them. It may take a year or longer for warts to finally disappear.

Next blog: Molluscum Contagiosum

 

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Teething Trio of Trouble

Recently the FDA issued a warning regarding homeopathic teething tablets and gels marketed by Hyland’s.  Parents who have experienced any illness in their infant from the tablets are encouraged to contact the FDA.  The issue is that the teething tablets contain a small amount of Belladonna.  Belladonna is a common weed which contains atropine-like compounds. Atropine is a drug which has a variety of uses including causing the pupils to dilate.  The Hyland’s tablets contain 0.0000000000003% Belladonna alkaloids which should be a safe enough dose; however the FDA is investigating if the company was properly controlling the amount.  Homeopathic remedies are approved for use in the USA; however they have no more benefit than a placebo.  Until further notice from the FDA it is advised to not use the Hyland’s Teething Tablets.

hylands

The FDA has also investigated the safety of teething gels such as Oragel which contain benzocaine.  In rare cases the benzocaine can cause methemoglobinemia which is a condition where the baby’s lips turn blue due to reduced oxygen in the blood.  Although this will not happen to most babies who use the gel why take the chance?  Teething is a mild problem for babies and can be treated in safer ways such as teething rings and toys.  Babies like to explore their environment by putting things in their mouth.  Just because he or she is doing so doesn’t mean they are in pain. If your baby is fussy it may have nothing at all to do with his or her teeth.

necklace

Finally the amber teething necklace … Looks nice, but doesn’t do anything!  It is also a choking and strangulation hazard. Not recommended! Here is a link with some helpful suggestions for teething. Have a great day!

Dr Mo

Parenting Challenges

Those of you who know me well have heard me say, “every child is different” or “some children are more challenging to deal with than others”.  All pediatricians field a lot of questions about picky eaters and how to get kids to eat their vegetables.  As parents we are facing many challenges with respect to our children’s diets.  The daily pressures to get kids to school, then to after school activities can often lead to problems at mealtime.  After a long day I don’t always want to expend a lot of effort to prepare dinner for the family (and neither does my wife).   I also don’t want to have a big battle at the dinner table regarding what we are having.  So the challenge is to whip up something quick, that everyone can agree upon, and it has to be healthy.  Sound familiar? Obviously with picky kids that can be tough.  At the Mosolf house we usually have some kind of protein, a vegetable, a carbohydrate and fruit,  The fruit is a compromise because the kids won’t usually eat the veggies. When I put out a plate of baby carrots or salad they will probably eat that, but not much else (maybe some broccoli with cheese sauce or fresh green beans).  So one of the kids is a bit overweight. We have tried to advise him to eat smaller portions and healthier options, but we get a lot of push back.  Swim team 3 or 4 days a week worked well for a few years to keep the weight under control, but now we are running out of options. My latest strategy has been to “phone a friend”.  Getting some help from the outside can be a good option when normal parenting fails.  Receiving advice from a neutral third party such as a nutritionist or dietitian is easier for headstrong kids. They don’t feel like mom is picking on them or criticizing. Also there are TED talks, TV shows and documentaries about nutrition such as Fed Up that can help children to see their bad habits.   The challenge is to be a good parent without creating a toxic and confrontational environment in the home.  If you are having problems at home with your child’s diet ask me about it when you come in for your check up.  I usually converse directly with the child or teen to try and help them understand about healthy choices and lifestyle.  Occasionally they listen to me. I am always happy when a patient comes in and he or she has decreased their Body Mass Index.  They usually say something like, “I just decided to eat healthy foods such as salads and avoid junk food”.  It is something that the patient decided to do for him or herself.  If the parent is trying to manage every morsel of food that enters the kid’s mouth that is not going to work. Do you have control over what they eat at school?  Do you have a padlock on the pantry and fridge?  He or she has to want to make some changes first.   After that it is our job to help them out and encourage them in any way we can.  Keep the home stocked with healthy options.  Beware of misinformation regarding what is healthy.  Talk to me or some other nutrition professional if you need help.

Comments about Paul Offit, MD’s book, Do You Believe in Magic?

I read Paul A. Offit M.D.’s book, Do You Believe In Magic? in which he takes on Dr. Oz and Andrew Weil among others. Dr. Offit argues that alternative medicine is fine until it crosses certain lines. If a practitioner advises against a conventional medicine treatment that might save a life such as chemotherapy for cancer or insulin for diabetes then that is wrong. Another example of alternative medicine gone wrong is when the cost is astronomical. Patients and their families are very vulnerable when they receive a devastating diagnosis. They will pay anything for unproven therapies that offer some hope.   Examples of less expensive alternative treatments are amber necklaces for teething and plastic bracelets (with metal discs) to improve coordination. Any benefit from these is due the placebo effect.

I have noticed a lot of families buy expensive vitamin supplements for their children. It seems that their money would be better spent on a gym membership, college savings or a nice vacation. But that is a personal decision.
Vaccines have been under attack ever since I started practicing pediatrics in 2000. First it was the MMR accused of causing autism. Next it was the preservative thimerosol which was supposedly to blame. Oprah, Jenny McCarthy and others helped to frighten millions of new parents about vaccines. Fortunately it seems most families recognize that those earlier claims are false; however many still think that we give too many vaccines to our children. I worry when parents choose not give certain vaccines or “miss” appointments for their well child visits thus falling behind on their vaccines. 
Doctors, Physician Assistants, Nurse Practitioners, nurses and scientists need to do a better job of promoting rational medical treatments. If history has taught us anything it is that careful reasoning and science are our hope for the future.
P.S. Buy Dr Paul A. Offit’s book. It will cost you less than a bottle of magic pills.

Review of the book: The Business of Baby by Jennifer Margulis

     I recently read The Long Walk: The True Story of a Trek to Freedom by Slavomir Rawicz which was first published in 1956. It is an account of his escape from a Soviet Gulag and trek across Siberia and Mongolia to India. The book inspired a movie in 2010 called The Way Back starring Ed Harris. While I really enjoyed the book I started to wonder if it was true. “Slav” and his band of friends walked for 12 days through the desert only stopping to drink muddy water once. Really? Near the end the author describes his close encounter with a Yeti.  Others have questioned the truth of the story including the BBC. I was disappointed to learn that the book is fiction. But isn’t that the case with a lot of what we see daily? Jimmy Kimmel recently perpetrated an internet hoax which went viral. Spam email often includes scams and crazy rumors. Now I check the Snopes website whenever I see a strange internet rumor. My favorite rumor is the one about applying Vicks to your feet to treat a cough. That one has been going around for at least five years.

     In April, 2013 The Business of Baby by Jennifer Margulis was featured in The Daily Beast. After reading the article I knew that the author was going to say a lot of negative things about pediatricians and obstetricians, but I was curious what she had to say. According to the author, hospitals in the US do just about everything wrong in labor and delivery. Nurses start an IV then put the mother in bed on her back. Next comes an epidural and medicines to induce labor which leads to a C-section and higher infant and maternal problems. The author also blames pediatricians for giving a bunch of expensive and dangerous shots in order to make money. On a positive note I liked her comments about potty training being unnecessarily delayed in the US. Also she berates the American Academy of Pediatrics for taking donations from infant formula manufacturers. I agree with her that taking donations from formula makers while promoting breast feeding seems wrong. The book was well written and thought provoking, but very one sided. Her assertion that prenatal ultrasounds cause autism was not backed up by much evidence. I would characterize the author as a sensationalist rather than a journalist. It was an enjoyable read, but weak on careful evaluation of scientific research.